Joint Inflammation, Stress, and Weight with Dr. Isabelle Amigues
Obesity is often linked to rheumatologic conditions(inflammatory or infectious conditions of the joints and other parts of the musculoskeletal system) and joint pain. This episode covers this connection, exploring how excess weight can impact these conditions. We'll also discuss the effects of weight loss medications on such conditions and the powerful impact of stress reduction techniques on healing both the mind and body.
I'm joined today by Dr. Isabelle Amigues, a physician and rheumatologist based in Denver, Colorado. Dr. Amigues trained in both Paris and Columbia University in New York City. After over five years on faculty at National Jewish Hospital, she opened her own direct care and concierge rheumatology practice in Denver called Unabridged MD.
She's also the host of the Unabridged MD podcast and is an accomplished researcher, authoring multiple book chapters and scientific articles, as well as being a sought-after speaker.
Link Between Weight, Obesity, and Rheumatologic Conditions
Understanding how weight and obesity are connected to various rheumatologic conditions and joint pain is really interesting. It's something many people might not know about.
As it turns out, obesity can cause inflammation, and this inflammation can trigger flares of rheumatoid arthritis and psoriatic arthritis, which are both highly inflammatory types of arthritis. What's really interesting is that researchers have found a link between the amount of fat someone has and their risk of developing these conditions and experiencing flares.
About 10 to 15 years ago, researchers like Dr. Giles at Columbia University started digging into this connection. They found that when they look at fat tissue, they see inflammation. And guess what? The more inflammation there is around the fat tissue, the more inflammation there tends to be in conditions like rheumatoid arthritis.
Now, they've even come up with ways to measure how much fat someone has using scans. In the world of rheumatology, it's not just about weight; it's about how much inflammation is in your fat tissue. If most of your body mass is muscle, you probably won't have as many issues.
It used to be that people thought the connection between weight and joint pain, like knee pain, was just because of the extra weight people were carrying around. But it's way more complicated than that.
The Surprising Link Between Weight Loss and Rheumatologic Relief
According to Dr. Amigues, in her practice as a rheumatologist, she's seen some significant improvements in her patients' rheumatologic problems, especially in those who are overweight or obese. Treating rheumatoid arthritis is relatively straightforward with existing medications, but psoriatic arthritis has been tougher, especially in overweight or obese patients. But here's the interesting part: Dr. Amigues has noticed that some of her patients with psoriatic arthritis who are also overweight or obese have shown remarkable improvement after losing weight.
One thing that caught Dr. Amigues's attention is that the anti-inflammatory effects of GLP-1 receptor agonists might be more than just about losing weight. Sure, having overweight or obese causes inflammation, but the anti-inflammatory effects she's seen in patients using these medications can't just be because they're losing weight. It seems these medications might have extra anti-inflammatory properties beyond just helping with weight loss. For example, a paper in Nature talked about how GLP-1 receptor agonists like semaglutide have anti-inflammatory effects that can help with various diseases, even Parkinson's.
All in all, it's an exciting time in medicine. GLP-1 receptor agonists aren't just about treating obesity anymore; they're offering hope for all sorts of health conditions. As a rheumatologist, Dr. Amigues finds these developments particularly intriguing because they offer new ways to manage rheumatologic conditions. The growth of these medications in recent years has been incredible, almost like the excitement surrounding the passing of the Affordable Care Act (ACA). Finally, there are treatments that can really make a difference in people's lives, and that's something to be genuinely excited about.
Metformin in Rheumatology
Metformin, a widely accessible and relatively inexpensive drug, has recently been gaining attention for its potential benefits beyond its traditional use in diabetes management. For instance, some rheumatologists are prescribing metformin to their overweight or obese patients to help with inflammation associated with rheumatic conditions.
However, the data supporting the use of metformin for rheumatologic conditions isn't as robust as for other medications. Although some studies have shown promising results in conditions like rheumatoid arthritis and spondyloarthritis, the evidence isn't as strong. Still, for patients who prefer to avoid or delay the use of more targeted therapies like biologics, metformin can be a reasonable option.
While metformin may not produce as dramatic results as some other medications, it can still offer some benefit, particularly when used in conjunction with other treatments. Some patients may find that metformin helps with inflammation and improves their overall condition, albeit in a more subtle way. And given its relatively low cost and long history of use, it's certainly worth considering as part of a comprehensive treatment plan.
In the end, the choice of treatment depends on various factors, including the patient's preferences, the severity of their condition, and any other underlying health issues. While biologics and other targeted therapies may offer more precise and effective treatment options for many patients, metformin can still play a valuable role, particularly for those who prefer a more conservative approach or who may not have access to more expensive medications.
Steroids in Rheumatology: Addressing Weight Gain and Side Effects
One medication that doesn't get talked about enough in rheumatology is steroids, particularly prednisone. While they can be life-saving for patients experiencing severe flares, steroids are notorious for causing weight gain.
According to Dr. Amigues, steroids are a bit of a double-edged sword. On one hand, they can be incredibly effective, especially for patients in critical condition. She tries to avoid them whenever possible due to their numerous side effects.
"One strategy I've found helpful is administering steroids intramuscularly instead of orally," she shares. "This not only ensures the medication lasts longer in the system but also reduces the risk of dependence. My primary goal is always to minimize the use of steroids and find alternative treatments with fewer side effects."
The weight gain that comes with steroids can be pretty significant, and it's often something patients can't control. It's a tough part of managing rheumatologic conditions, but it's something we need to talk about more openly and be proactive about.
Recognizing the side effects of steroids is crucial, especially the potential for weight gain. Dr. Amigues remembers one patient who didn't gain weight on steroids but instead happened to developed type 1 diabetes and started losing weight rapidly. Recognizing this as a potential sign of diabetic ketoacidosis, a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones, Dr. Amigues acted quickly to prevent a potentially life-threatening situation. It's cases like this that show why it's so important to closely monitor patients on steroid treatment and address any side effects that come up.
Stress and its Impact on Health: A Personal Journey
The link between stress and inflammation is crucial for comprehending its profound impact on our bodies. This connection became particularly evident to Dr. Amigues when she was diagnosed with stage four breast cancer over five years ago. Faced with such a daunting diagnosis, she began exploring ways to aid her healing journey, leading her to discover the power of the placebo effect and its potential to positively influence health outcomes.
As a rheumatologist, Dr. Amigues is naturally inclined to be optimistic, having witnessed numerous patients achieve remission from severe conditions. This sparked her curiosity: What differentiates those who recover well from those who struggle? Her exploration led her to investigate the power of the mind in healing. Stress, she learned, is pro-inflammatory, exacerbating conditions like cancer or rheumatological disorders. Understanding this, she delved deeper into the science of stress and its effects on the body.
Stress triggers the body's sympathetic nervous system, preparing it for fight or flight responses. However, prolonged stress can hinder the body's ability to heal by preventing the activation of the parasympathetic nervous system, which promotes relaxation and healing. To counteract this, Dr. Amigues discovered the importance of tapping into the parasympathetic system through various methods, including visualization and meditation. By acknowledging and managing stress, individuals can create a conducive environment for healing.
It's crucial to recognize that stress doesn't just affect mental well-being; it profoundly impacts physical health, including weight management. Chronic stress can exacerbate health problems, becoming a self-perpetuating cycle. This understanding underscores the significance of addressing stress as part of a holistic approach to health care. By recognizing the mind-body connection and implementing strategies to reduce stress, individuals empower themselves to support their bodies in their natural healing processes.
In this episode, we explored how obesity is linked to rheumatologic conditions and joint pain. Dr. Isabel Amigues shared insights into how excess weight exacerbates these conditions and discussed the impact of weight loss medications and stress reduction techniques on healing. From recognizing the link between weight and rheumatologic conditions to discussing the potential of medications like GLP-1 receptor agonists in managing inflammation, we've uncovered promising avenues for improving patient outcomes. Let's remember the interconnectedness of our physical and mental well-being. By addressing obesity, managing stress, and exploring innovative treatment options, we can empower ourselves to live healthier lives. For more in-depth information, please listen to the full podcast episode.
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